watercolor8: Zolpidem taper help

[watercolor8]

Currently prescribed by neurologist for Akathisia:

7.5 mg Zolpidem (Ambien) 3 x day (tapered from 30 mg Dec, 2020-Feb, 2021)

600 mg Gabapentin

80 mg Propranalol

1.25 mg Clonazpam

22.5 mg Mirtazapine (Remeron)

 

Fast 2 month taper off  Cymbalta Spring, 2020 due to Tardive Dyskinesia

Akathisia began Summer, 2020

Neurologist had me stop other medications abruptly (Clonazepam, Doxycycline, prednisone)

Began with propranalol and meds increased through Fall, 2020 to above current dose.

Thinking I should continue taper zolpidem first, as this would be the drug removed if I had to be hospitalized, but don't know how to reduce it past just breaking the tablets. (Neurologist thinks I should stay on it, or fast taper in 4 weeks. Neurologist also thinks I can just stop the mirtazapine if I choose, with no taper) I can't find specific info on dry or liquid taper for zolpidem.

Edited June 14, 2021 by Gridley

[Gridley]

Welcome to SA, watercolor8.  Thanks for completing your drug signature.

 

Regarding your neurologist's opinion, we would not agree that you can fast taper the Zolpidem or that you can cold turkey the Mirtazapine.  Cold turkey is the tapering method that puts you at greatest risk of withdrawal symptoms, and a 4-week taper off 22.5mg Zolpidem is far faster than we recommend.  We recommend tapering by no more than 10% of your current dose every four weeks.

 

Why taper by 10% of my dosage?

 

The following link contains specific information for tapering Zolpidem (Ambien), including how to do both a dry or a liquid taper.  So you don't have to resort to just breaking the tablets.  Once you've chosen a method (dry or liquid) we can further advise you and answer any questions you have about the taper method.

 

Tips for tapering off Z drugs for sleep (Ambien, Imovane, Sonata, Lunesta, Intermezzo, etc.) 

 

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system. 

 

Magnesium, nature's calcium channel blocker 

 

Omega-3 fatty acids (fish oil) 

 

Add in one at a time and at a low dose in case you do experience problems. Get supplements that are single ingredient (not mixed with other types of supplements).

 

This is your Introduction topic, where you can ask questions and connect with other members.  We're glad you found your way here.

Edited June 14, 2021 by Gridley

[watercolor8]

Thanks. So if I wanted to taper 5% of a 5mg tablet of zolpidem, how much water for the 5 mg tablet?

[Gridley]

24 minutes ago, watercolor8 said:

Thanks. So if I wanted to taper 5% of a 5mg tablet of zolpidem, how much water for the 5 mg tablet?

I'm not expert on liquid tapers, so I've brought your question to the attention of the other staff.

[watercolor8]

Let me rephrase that. I take 1 1/2 5mg tablets 2x day, and a 5 mg tablet at night. Want to reduce the 1st 2 down to 5 mg each by tapering. Can I reduce the 7.5 dosages to 5 mg by stopping the 1/2 tablet one at a time? That's 2.5 mg - more than 10% of total (20 mg total) Apologies- typing during akathisia 

[Altostrata]

Welcome, @watercolor8

 

4 hours ago, watercolor8 said:

Currently prescribed by neurologist for Akathisia:

7.5 mg Zolpidem (Ambien) 3 x day (tapered from 30 mg Dec, 2020-Feb, 2021)

600 mg Gabapentin

80 mg Propranalol

1.25 mg Clonazpam

22.5 mg Mirtazapine (Remeron)

....

 

This is an unusual kitchen sink cocktail of drugs for akathisia. Did your akathisia go away? When did this happen?

 

If your akathisia is resolved, why do you want to go off Zolpidem first? It's highly unusual for a doctor to prescribe it in the daytime, especially since you're also taking clonazepam. They are related drugs.

 

Having got you into this interesting cocktail, why does this neurologist not know how to deprescribe it?

 

What times of day (o'clock) do you take your drugs, with their dosages?

[watercolor8]

Thank you for your reply. The Akathisia is still strong and agonizing, often completely disabling. I worry that if I have to be hospitalized or have a procedure, they would stop the Zolpidem suddenly because of high dosage not being safe, especially if I needed anesthesia or other medication, and I would have serious withdrawal. I only found one reference to 30 mg Zolpidem being prescribed for Akathisia, and that was in a study paper written by my neurologist. I'm disappointed that the top movement disorder neurologist group prescribed this nightmare, and that they don't see a reason to discontinue it (they actually want to add more meds) and they think that if I push for tapering, that I can do a 2-4 week taper on the Zolpidem and also just discontinue the Mirtazapine abruptly. 

5 am: 200 mg Gabapentin + 40 mg Propranalol

6 am: 7.5 mg Zolpidem

11 am: 200 mg Gabapentin + 40 mg Propranalol

12n: .5mg Clonazepam

2 pm: 7.5 mg Zolpidem

5 pm:200 mg Gabapentin + 40 mg Propranalol

6 pm: .25 mg Conazepam

9:30 pm 15 mg Mirtazapine

10 pm: 7.5 mg Mirtazapine + 5 mg Zolpidem

2:30 am: .5 mg Clonazepam

The Zolpidem (originally 30 mg) was given for Akathisia, not sleep. At first I didn’t sleep at all, now I get @ 2.5 broken hours. None of the meds are sedating.

The Akathisia is so bad I didn't realize how ploydrugged I was getting. I guess I thought it would stop the agony. I also didn't know about these forums and tapering information. Also, unfortunately, the few times I doze off, it happens during what should be a medication time, so I end up taking it late. My last Zolpidem taper was over 3 months ago, but since it was probably too fast, I've been holding. I am overwhelmed, confused and scared, but I keep reading that the only way to possibly stop the akathisia is to taper off all meds, very slowly.

[watercolor8]

I thought I'd reduce the Zolpidem to 15 mg, then hold, and start tapering the Clonazepam next. I don't know which drug is the most likely to be exacerbating the Akathisia, or if part of it actually withdrawal Akathisia.

[watercolor8]

 

Currently prescribed by neurologist for Akathisia:
7.5 mg Zolpidem (Ambien) 3 x day (tapered from 30 mg Dec, 2020-Feb, 2021)
600 mg Gabapentin
80 mg Propranalol
1.25 mg Clonazpam, divided doses:  (.5mg 2:30 am, .5mg 12noon, .25 mg 5pm)
22.5 mg Mirtazapine (Remeron)

 

I want to begin with reducing either the zolpidem or the clonazepam by 10% using water/liquid titration

for clonazepam, would prefer to do the taper first on late night dose first

 

My severe akathisia affects my cognition and math. I've been stuck on this for months (tapered a bit to quickly from original 30mg zolpidem by breaking into half, then 4ths to get to present 20mg, but last taper on that was in Feb)

i would like to know: amount of pill + amount of liquid, mix, remove 10% by medicine dropper or syringe

[Altostrata]

Yes, it's not good medical practice to prescribe a batch of drugs to crush a symptom. That neurologist should stick to neurology.

 

On 6/14/2021 at 5:57 PM, watercolor8 said:

None of the meds are sedating.

 

All of those meds are sedating. Are you saying none have a sedating effect on you?

 

My guess is you're taking such a high load of sedating drugs, they are having a paradoxical effect on you. They are activating instead of sedating.

 

I would not touch the clonazepam until the last.

 

I find it incredible that anyone would prescribe zolpidem to be taken throughout the day when you're already taking clonazepam in multiple daily doses.

 

In your signature, please add the dates you started each of the drugs. Which did you add last, and how long have you been on it?

 

Please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

Please keep daily notes of times of day you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time of day on the left and notation (symptom or drug and dosage) on the right. This can show which of your drugs are causing the worst effects.

 

[watercolor8]

Thanks-I put my dosage times in my signature. That’s as far as I could get. 
akathisia symptoms do not seem to be drug related as much as progressing through afternoon to night. 
but how much water do I need to add to say a 5 mg tablet of my 7.5 morning dose( my total zolpidem is 20 mg, so I guess I would be reducing 2 mg, which is less than 1/2 tablet, and it won’t cut evenly) Thank you